title: Is a fluorescence navigation system with indocyanine green effective enough to detect liver malignancies?
abstract: BACKGROUND
  Although several reports have shown the efficacy of a fluorescence navigation system (FNS) with indocyanine green (ICG) to detect liver malignancies during hepatectomy, the real accuracy of this procedure is not yet clear. This study aimed to analyze the actual efficacy of ICG-FNS in cirrhotic and non-cirrhotic livers.
  
  
  METHODS
  Ten cirrhotic whole livers explanted from liver transplant recipients and 23 non-cirrhotic livers from patients who underwent hepatectomy for various kinds of liver tumors were investigated with ICG-FNS. All surgical specimens were analyzed macroscopically and pathologically.
  
  
  RESULTS
  In the patients with a cirrhotic liver, most nodules illuminated by ICG-FNS were diagnosed as regenerative nodules pathologically. The positive predictive value was 5.4%. There was a significant difference in positive predictive value to detect malignant liver tumors between cirrhotic liver and non-cirrhotic liver (5.4% vs 100%, P < 0.0001). In the non-cirrhotic livers, 11 of 33 (32.4%) tumors were not recognized by ICG-FNS through the liver surface before resection. There was a significant difference in the depth from the liver surface to tumor between illuminated nodules and non-illuminated nodules (1.5 mm vs 11.6 mm, P < 0.01).
  
  
  CONCLUSIONS
  It is necessary to know the limitation of ICG-FNS when detecting liver malignancies in both cirrhotic and non-cirrhotic livers.
authors.affiliation: Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Tanaka
authors.forename: Mitsuhisa
authors.initials: M
authors.lastname: Takatsuki
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hidaka
authors.forename: Takanobu
authors.initials: T
authors.lastname: Hara
authors.forename: Izumi
authors.initials: I
authors.lastname: Muraoka
authors.forename: Akihiko
authors.initials: A
authors.lastname: Soyama
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Adachi
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Kuroki
authors.forename: Susumu
authors.initials: S
authors.lastname: Eguchi
mesh_terms: D000328:Adult; D000368:Aged; D004396:Coloring Agents; D015897:Comorbidity; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D008103:Liver Cirrhosis / Q000453:epidemiology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: Fluorescence navigation system; Indocyanine green; Liver tumor